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Determining Policy Adequacy and Levels of Implementation for the Attainment of the Millennium Health Goals: the Case of Malaria Control in Uganda

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Determining Policy Adequacy and Levels of Implementation for the Attainment of the Millennium Health Goals: the Case of Malaria Control in Uganda DETERMINING POLICY ADEQUACY AND LEVELS OF IMPLEMENTATION FOR THE ATTAINMENT OF THE MILLENNIUM HEALTH GOALS: THE CASE OF MALARIA CONTROL IN UGANDA A THESIS SUBMITTED TO THE SCHOOL OF GRADUATE STUDIES FOR THE AWARD OF THE DEGREE OF DOCTOR OF PHILOSOPHY OF MAKERERE UNIVERSITY BY Rosalind Grace Namiiro Lubanga Makerere University Department of Social Work and Social Administration P.O. Box 7062, Kampala, Uganda September 2010 0 DEDICATION This work is dedicated to my late mother Victoria Nankinga Lubanga, my late father Isaya Lubanga, and late maternal grandmother Yuliya Nabasirye; all of whom never lived to cerebrate with me the completion of my doctoral program and get the joy out of their contributions to my education.. It is also dedicated to a late friend and benefactor, Professor Rosemary Mills who inspired, influenced, and sponsored me to do social work at graduate level for purposes of developing skills to engineer solutions to societal social problems and help improve the well being of someone out there i ACKNOWLEDGEMENTS The successful completion of this piece of work has been made possible by various forms of support ranging from funding, technical, moral support, and cooperation received from different individuals and organisations. First of all, I am grateful to the Vice Chancellor of Makerere University Professor Livingstone Luboobi and his senior administrators for accepting to fund my doctoral program and this study. I am grateful for the two years of study leave given to me to undertake this doctoral work. I am grateful to SIDA SAREC Program for the extra funding given to me, as well as the encouragement and stimulation without which I would not have been able to complete this study. Special thanks go to the Senior management of my mother faculty, the Faculty of Social Science especially Professor Edward K. Kirumira for having considered me worthy to benefit from the SIDA SAREC program. I wish to thank the SIDA SAREC managers in Sweden and especially Dr. Margareta Espling of Göteborg University for her administrative support and the arrangements made for me to visit Göteborg several times to enable me expeditiously work on this study. Special gratitude goes to my supervisors: Professor Edward K. Kirumira, of the Faculty of Social Sciences, Makerere University; Professor Staffan Höjer of the Göteborg School of Social Work, Sweden; and Dr. George W. Pariyo of the Department of Health Policy Planning and Management, Institute of Public Health - Makerere University, for their unwavering intellectual input in this work, their encouragement, understanding, social and moral support. My supervisors read a number of huge drafts and never complained or discouraged me. I thank Dr. Ronny Heikki Tikkkanen of Göteborg School of Social Work for teaching me the Statistical Package for the Social Sciences (SPSS) computer program. I am equally indebted to Dr. Okuonzi Sam Agarte and Prof. Charles Rwabukwali for the inspirations given me to undertake this policy study, and for their initial assistance in its conceptualization. I am equally indebted to Prof Patrick Muzaale my social work mentor for his intellectual support rendered to me during this study and throughout my professional life. I am grateful to all those scholars who attended my PhD defence and gave useful contributions for the improvement of this thesis. Special thanks go to Dr. Ambrose Talisuna who willingly accepted to review the thesis and acted as my defendant during my defence. I am also highly indebted to Dr. Narathius Asingwire my head of department, a colleague and friend for the different forms of support given to me during this period. I am thankful to all colleagues in the department of social work – Dr. David Kyaddondo, Dr. Julius Omona, Agatha Kafuko, Eddy Walakira, Swizen Kyomuhendo, Jane Lunkuse, Flavia Nakacwa, Patrick Kisuule Juma, Vincent Lubega and Stephen Nsibambi for their support and assistance. I am grateful to all my respondents in the two study districts of Mukono and Mpigi districts for their cooperation to answer the many questions without which this study would not have been successful. In both districts, my special thanks go to the district health officers and their medical teams, the health unit managers, medical superintendents and administrators of hospitals, and especially that one of Kawolo Hospital; heads of government departments and sub- county chiefs in Ntenjeru, Seeta Namuganga, Nkozi and Kabulasoke as well as technical staff in the municipalities of Lugazi and Mpigi Town Councils. I thank the Ministry of Health Officials, especially Dr. Kato and Dr Lugemwa Myers in the Malaria Control Program who introduced me to the malaria control policy and implementation guidelines. I wish also to thank the various officers in charge of the resource centres which I visited and obtained materials from both in Sweden and Uganda. These included: the Uppsala Nordic Institute of African Studies, and the Göteborg University Library. Other libraries included Makerere University Main Library, the UBOS resource centre, the MoFPED resource centre, the ii UNDP resource centre, the Malaria Consortium, MoH resource centrer and NEMA resource centre. Dawuda Waisswa in the Sociology Department of Makerere University gave me a lot of materials on malaria for which I am grateful. Dr. Moses Kamya in the Makerere Medical School was also very helpful in updating me about new things on malaria control in the country. Special thanks go to my research assistants Rosette Nakubulwa, Joseph Kizito, Sarah Nakamya, and Sekamatte Jackson who withstood the rain, the heat, dust, expanse forests, swamps and savanna land of Mukono and Mpigi districts; and who many times got lost in the course of searching for the randomly selected households. I deeply thank the community development officers and parish chiefs who mobilized the communities for the study notably: Mukwaya James, Annet Nabuuma, Walugembe Edrisa, and Kalagi. I thank my data entry clerks Isaiah Kizito and Herbert Senkumba for the work well done. To my children, Sarah, Jane, Herbert, Isaiah, and Gerald, I am deeply indebted for their support. I thank Sarah for proof reading and editing the manuscript. I cannot forget my sisters Faith Nalongo Kaggwa and Mrs Margaret Kibuuka, and our husbands Mr. Kasozi Abby and Mr. JB Kibuuka who have always stood by me in difficult times. To all the other persons including my immediate and wider family, as well as friends who have rendered me one form of support or the other, please accept my humble and sincere appreciation. Last but not least I thank God for the life He has given me, the wisdom and energy to complete this study. I cannot forget my pastor Edward Bwanika of Kiremezi for his prayers and standing with me in thick and thin. Thanks also go the entire church at Kiremezi who always pray for me. Thank you all. May God bless every body. Rosalind Grace Namiiro Lubanga September, 2010 iii TABLE OF CONTENTS PAGE DEDICATION.............................................................................................................................................. i ACKNOWLEDGEMENTS ............................................................................................................................ ii LIST OF TABLES/FIGURES/MATRICES ......................................................................................................viii LIST OF TABLES IN THE TEXT ...................................................................................................................viii LIST OF TABLES IN THE APPENDIX ..........................................................................................................viii LIST OF FIGURES IN THE TEXT .................................................................................................................. ix LIST OF MATRICES IN TEXT ...................................................................................................................... ix LIST OF MATRICES IN APPENDIX.............................................................................................................. ix LIST OF BOXES .......................................................................................................................................... x ABBREVIATIONS AND ACRONYMS .......................................................................................................... xi DEFINITION OF SOME TERMS .................................................................................................................xiii ABSTRACT .............................................................................................................................................. xiv CHAPTER ONE .......................................................................................................................................... 1 POLICY ADEQUACY AND ACHIEVEMENT OF THE MILLENNIUM DEVELOPMENT HEALTH GOALS IN SUB- SAHARAN AFRICA .................................................................................................................................... 1 1.1 Concerns prompting the study........................................................................................................ 1 1.2 Meaning of policy ........................................................................................................................... 4 1.3 Meaning of implementation and its relationship with policy ........................................................... 8 1.4 Meaning and importance of the Millennium Development
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